Healthcare Provider Details

I. General information

NPI: 1598674541
Provider Name (Legal Business Name): PSYCHIATRIC WELLNESS CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S DURKIN DR STE 101
SPRINGFIELD IL
62704-8903
US

IV. Provider business mailing address

975 S DURKIN DR STE 101
SPRINGFIELD IL
62704-8903
US

V. Phone/Fax

Practice location:
  • Phone: 217-836-7011
  • Fax:
Mailing address:
  • Phone: 217-836-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY A EARL
Title or Position: PMHNP, NP-BC
Credential: PMHNP, NP-BC
Phone: 217-836-7011